Objective. To establish whether health utility (time trade-off, TTO) and willingness to pay (WTP) values reflect clinical health outcome as evaluated by the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) in hip and knee osteoarthritis (OA). Methods. One hundred twenty-eight patients with OA attending a specialized arthritis clinic were interviewed about their socioeconomic characteristics and administered the TTO technique and the WOMAC. Their WTP for 2 hypothetical anti-osteoarthritic drugs was also investigated: the first drug was said to provide a significant improvement in WOMAC dimensions and the second a complete cure of the disease. WTP was elicited by both discrete-choice and bidding game methods. Results. Answer rates were 89.1% for TTO, 98.4% for discrete-choice WTP for both scenarios, and 89.8% and 85.2% for bidding game WTP in the relief and the cure scenario, respectively. The mean TTO utility value was 0.84 (standard deviation 0.20). In discrete-choice, those accepting the bid had higher monthly income (euro 1536.5 vs euro 1060. 1, p < 0.001, for the relief scenario and euro 1449.3 vs euro 1071.6, p < 0.001, for the cure scenario). With the bidding game format, WTP was positively correlated with income in both scenarios (r = 0.56, r = 0.55, p < 0.001). WTP measures differed equally between education and socioeconomic groups with those in favored groups consistently reporting higher WTP (Kruskal-Wallis tests statistics ranging from p < 0.01 to p < 0.001). Except for stiffness, WOMAC dimensions were correlated in the expected direction with TTO values (r = -0.27, p < 0.01 for pain and r = -0.36, r = -0.34, p < 0.001 for physical function and total score, respectively). Conclusion. Whereas they showed good feasibility, WTP measures poorly reflected clinical condition and were mainly related to economic status and ability to pay. TTO was correlated with the WOMAC dimensions and may be considered closer to clinical situations than WTP. However, concern arises regarding the homogeneity of the study sample in terms of clinical severity, which may have precluded the identification of a relationship between WTP and clinical status. [less ▲]

Background: During the last two decades of the 20th century, hormone replacement therapy (HRT) has been considered as the sole pharmacological approach for counterbalancing or mitigating the effects of ... [more ▼]

Background: During the last two decades of the 20th century, hormone replacement therapy (HRT) has been considered as the sole pharmacological approach for counterbalancing or mitigating the effects of estrogens deprivation in post-menopausal women. Subsequently, HRT has been widely recommended for the management of chronic diseases occurring, in women during the second half of their life. The overall risk/benefit ratio of estrogens has been recently reassessed in the light of long-term prospective studies failing to demonstrate the expected benefit of HRT on cardiovascular diseases incidence. Osteoarthritis (OA) is one of the chronic conditions for which HRT has been suggested to provide beneficial outcomes. Results: The presence of estrogen receptors in human cartilage is no longer debated. However, cellular or animal models of OA do not provide an unequivocal pathway for the influence of gonadal steroids on cartilage. Similarly, studies attempting to correlate serum or urinary levels of sex steroids to the onset or progression of OA gave conflicting results. No randomized, prospective, controlled trial was designed to specifically assess the impact of hormone replacement therapy on symptomatic or structural progression of OA. Large-scale observational studies or trials designed to assess other potential benefits of estrogens suggest that HRT use does not provide symptomatic relief in OA but may interfere with its long-term structural progression, particularly in the lower limbs. Conclusion: Based on the recent results of the Women Health Initiative suggesting that HRT health risks may outweigh benefits, one can hardly recommend, with the current level of evidence, HRT as a first-line treatment against progression of OA. (C) 2003 OsteoArthritis Research Society International. Published by Elsevier Science Ltd. All rights reserved. [less ▲]

in Gynecological Endocrinology : The Official Journal of the International Society of Gynecological Endocrinology (2002), 16(3), 245-250

A simple questionnaire would be useful to identify individuals most in need of bone mineral density (BMD) testing. We designed a new predictive model and risk assessment instrument based on an extensive ... [more ▼]

A simple questionnaire would be useful to identify individuals most in need of bone mineral density (BMD) testing. We designed a new predictive model and risk assessment instrument based on an extensive review of the literature evaluating risk factors for osteoporosis, and tested its performance in a large cohort of postmenopausal women in whom BMD was measured by dual x-ray absorptiometry. In total, 1303 postmenopausal women from an outpatient osteoporosis clinic participated in this study. The Osteoporosis Index of Risk (OSIRIS) is based on four variables: age, body weight, current hormone replacement therapy use and history of previous low impact fracture. The sensitivity and specificity for an OSIRIS value of +1 were respectively 78.5% and 51.4%. The AUC under the ROC curve of OSIRIS was 0.71. Three categories were arbitrarily created using OSIRIS, with cutoff of +1 and -3. The low risk category (OSIRIS > +1) represented 41% of all women; only 7% of the women in this category had osteoporosis. The prevalence of osteoporosis was very high (66%) among the group at high risk (OSIRIS < -3 representing 15% of all women). The prevalence of osteoporosis was 39% in the intermediate risk group (-3 < OSIRIS < +1, 44% of all women). In conclusion, OSIRIS is a simple index based on four easy-to-collect variables from postmenopausal women, it shows a high degree of accuracy, and performed well for classifying the degree of risk of osteoporosis in western European women of Caucasian lineage. Based on this instrument it is possible to propose a strategy that would initiate treatment in women with very high risk, postpone BMD measurement in women with low risk and limit BMD measurement to women with intermediate risk of osteoporosis, this would spare more than 55% of the densitometry bill compared with a mass screening scenario. [less ▲]